Many topics in the behavioral sciences and epidemiology require researchers to directly observe entities (e.g., individuals, households) over a long time to identify lasting effects. Long-term panel data collection is more common in high-income countries than in small-scale rural societies (SSRS) of low-income countries. SSRS are mobile, nature-dependent, linguistic minorities, and highly autarkic. Analyzing such data using a life-course perspective can help uncover patterns that align or upend what we know from high-income countries. This study a) reviews long (>similar to 10 year) panels in SSRS (n = 9), b) extends the analysis to cover somewhat comparable societies of smallholders (n = 7) who are less autarkic, and c) draws on annual panel data (2002-2010) from one SSRS in the Bolivian Amazon (Tsimane') to illustrate how adult life-course patterns may vary but also resemble patterns in high-income countries. In general, panels have focused more on human biology than on socioeconomic outcomes, have gathered data at irregular intervals, and have not deposited datasets in public repositories. Compared with people in high-income countries, Tsimane' were similar in the amount of intragenerational immobility at the very top and the very bottom of the income and wealth distribution. In both places, body weight rose while sociality frayed over time. Yet Tsimane' differed in having more economic mobility outside the top and bottom income and wealth distribution, a slightly higher growth rate in economic inequality, and no correlation between economic mobility and age. We identify institutional and individual hurdles to collecting panel data in SSRS and discuss steps to overcome them.

The Greater Horn of Africa suffered the worst drought in >40 years between late 2020 and early 2023. Using a prospective, interdisciplinary unbalanced panel study between 2019-2024 among Daasanach pastoralists in northern Kenya, we measured the effects of and recovery from this drought in relation to experiential and objective measures. We examined water and food insecurity, coping and dietary strategies, and nutritional status among 515 adults and 384 children. Livestock herds dropped precipitously with little recovery by 2024. Individuals' consideration of moving due to water problems alongside experiential water and food insecurity scores increased substantially during the drought indicating severe distress but returned to pre-drought levels by 2024. The drought led to lower mobility, which continued post-drought for Daasanach and their remaining animals, indicating increased sedentarization. Milk intake declined drastically but rebounded by 2024. In contrast, meat intake declined and stayed lower a year post-drought, while consumption of previously stigmatized fish increased. As the drought progressed, nutritional status worsened. Children who consumed milk had significantly better nutritional status over time. Compared to men, women experienced greater levels of water and food insecurity and greater declines in adiposity at the drought's peak. Lower socio-economic standing was associated with worse outcomes except nutritional status over time. Overall, experiential measures of water and food insecurity recovered faster than livestock and nutrition, while shifts in livelihood and dietary strategies persisted post-drought. Policymakers should use these findings to inform drought mitigation plans as diversification of diet and livelihoods may help ameliorate negative impacts.

OBJECTIVES:Extreme weather events, like drought and heat stress, make it harder to meet water needs in water-insecure settings, particularly vulnerable groups. This study examines how short-term (heat stress) and long-term (drought) water stress affects hydration status across reproductive states (pregnant, lactating, compared to non-pregnant/non-lactating) for Daasanach semi-nomadic pastoralist women in northern Kenya. METHODS:Drawing on unbalanced panel data, we analyzed 565 observations from 303 women (aged ≥ 16 years) in 2019-2024. Hydration was assessed via urine specific gravity (USG) with dehydration classified as USG > 1.020. Environmental heat stress was measured by ambient temperature and humidity, with sensitivity analyses using wet bulb globe temperature. RESULTS:Mixed effect logistic regression models indicated ambient temperature and humidity were significantly associated with greater odds of dehydration across all women. Holding heat stress constant, lactating but not pregnant women had higher odds of dehydration than non-pregnant/non-lactating women. A significant interaction between heat stress and reproductive status indicated that the probability of dehydration increased fastest for pregnant women as temperatures rose. Holding heat constant, dehydration probability increased during drought years compared to pre- and post-drought and was most pronounced among lactating women. CONCLUSIONS:Ambient heat stress increases dehydration risk among Daasanach women with effects compounded in pregnancy, though overall lactation was the period of greatest vulnerability to dehydration. Dehydration probability peaked during the drought illustrating how long-term periods of water scarcity also challenge water needs. Heat stress and droughts exacerbate maternal and infant health risks; thus, targeted hydration and cooling interventions are needed.

Changes in relative socioeconomic rank during adulthood (intragenerational mobility) are increasingly recognized as important determinants of health and other well-being indicators. Quantitative studies in high-income countries find that mobility in rank generally correlates with these outcomes, but the direction and mechanisms remain unclear. Evidence from small-scale societies is scarcer due to limited panel data. We examine the correlation between mobility and well-being indicators among 350 Tsimane' adults (age≥16y: women = 184; men = 166) in the Bolivian Amazon, using nine consecutive years of panel data (2002-2010). Guided by four theories (dissociation [any mobility harms], socialization [people adapt to any new rank], "falling from grace" [extreme downward mobility harms], and set-point ["effects" are temporary]) we assess how changes in quintile rank of material wealth correlate with four aspects of well-being in 2010: physical health, perceived health, sociality, and use of addictive substances. Results showed partial support for each theory and revealed that upward and downward mobility each correlated with a mix of favorable (e.g., lower likelihood of being overweight, greater food satisfaction) and unfavorable (e.g., increased anger) indicators. Importantly, mobility was not associated with most outcomes, lending support to set-point theory and highlighting that any mobility could correlate with tradeoffs in health and other well-being indicators. In sum, as in high-income countries, our findings reveal heterogeneity and ambiguities, and the need for a new theory that acknowledges the simultaneous gains and losses that correlate with socioeconomic mobility.

INTRODUCTION:In low-resource settings, exclusive breastfeeding (EBF) and household water security are recognized contributors to child health. Yet few studies have examined how they are related. OBJECTIVES:This study aims to (1) test the relationship between domains of household water insecurity and EBF cessation before 6 months, and (2) examine the association between water insecurity and recent child diarrheal disease and stunting. DESIGN:The Haramaya University Health and Demographic Surveillance System is a cross-sectional survey. PARTICIPANTS/SETTING:Mother-child (aged 6-59 months) dyads (n = 1019) were recruited from smallholder agricultural households in rural Eastern Ethiopia in 2019. MAIN OUTCOME MEASURES:The primary outcome was EBF cessation before 6 months. Secondary outcomes were children's diarrhea (last 2 weeks) and stunting. Exposure variables assessing water insecurity included time spent fetching water, objective water quality (Escherichia coli presence), water source reliability, and overall household water insecurity status (classified using the Household Water InSecurity Experiences Scale). STATISTICAL ANALYSES:Survey logistic regression models were used to assess associations of water insecurity domains with early EBF cessation, diarrhea, and stunting. RESULTS:Poor water quality (adjusted odds ratio [AOR], 1.42; 95% confidence interval [CI], 1.06-1.98), unreliable water (AOR, 1.44; 95% CI, 1.04-1.98), and water fetching time >30 minutes (AOR, 1.54; 95% CI, 1.15-2.05) were associated with early EBF cessation risk. Children in households classified as moderate (AOR, 1.54; 95% CI, 1.03-2.30) or high water insecurity (AOR, 2.07; 95% CI, 1.33-3.24) had a greater risk of diarrhea. No association was observed between domains of water insecurity and stunting. CONCLUSION:Multiple domains of water insecurity were associated with early EBF cessation, and overall water insecurity was associated with children's diarrheal risk. Water insecurity has been identified as a key programmatic and policy consideration for early childhood nutrition.

ABSTRACT Objective Extreme climatic events, like droughts, are increasing in frequency and severity. Droughts disrupt community livelihoods and resources with serious implications for human biology. This study investigated how chronic stress, measured by fingernail cortisol concentration (FCC), and water insecurity status were predictive of C‐reactive protein (CRP), a biomarker of inflammation, during a historic drought among Daasanach seminomadic pastoralists. Methods Data were collected at the height of the 2022 drought from 128 Daasanach household heads aged 16–80 years in northern Kenya using household surveys, anthropometric measurements, and dried blood spots to assess CRP levels and fingernails to assess FCC. We employed mixed‐effects linear and logistic regression models to examine the relationships between log‐transformed FCC, high water insecurity status measured via the Household Water Insecurity Experiences (HWISE ≥ 24) scale, and serum‐equivalent CRP (log‐transformed and dichotomized at mild, low‐grade inflammation ≥ 1 mg/L) adjusted for covariates. Results The mean serum‐equivalent CRP was 4.1 mg/L and 56.3% of Daasanach adults had at least mild, low‐grade inflammation. Linear models indicated that ln(FCC) was positively associated with ln(CRP) ( β = 0.56, SE = 0.12; p < 0.001). Further, logistic models demonstrated that ln(FCC) (OR = 2.69, 95% CI: 1.84–3.95; p < 0.001) and high water insecurity (OR = 2.23, 95% CI: 1.34–3.72; p = 0.002) were both associated with greater odds of low‐grade inflammation. Conclusion This study provides evidence for how chronic stress and severe water insecurity may impact inflammation levels among pastoralists during drought. Since inflammation is central to cardiometabolic disease etiology, this is an additional reason to mitigate the negative health impacts of droughts and water insecurity exacerbated by climate change.

BACKGROUND:New metrics of household water insecurity have been validated for low- to middle-income countries, but it is unclear how these measurements apply to the experiences of people living in high-income countries. This project aims to develop and validate a novel metric for household water insecurity experiences in the United States (HWISE-USA) using a cross-sectional design and data from the Southwest, Midwest, and Western regions. METHODS:We outline the protocol for the development and validation of a novel household water insecurity scale for the United States to address this scientific need, including the following key steps: (1) item development through literature and theory; (2) pre-testing of items and expert review; (3) scale development and item reduction; and (4) scale validation. To assess the performance of the HWISE-USA scale, we will follow the same scale development analytics on a separate, quasi-nationally-representative U.S. sample. The scale will be generated from household survey data collected from communities at risk of water insecurity throughout the United States. DISCUSSION:We explain how a novel metric of water insecurity experiences for households in the United States has important implications for resource allocation, structural interventions, public health and infrastructure planning, and reductions in inequalities. REGISTRATION:osf.io/zvqs4.

INTRODUCTION:This study assessed how the intersection of water insecurity and food insecurity is associated with sugar-sweetened beverage intake among U.S. children and adolescents. METHODS:Data from 18,251 children in the cross-sectional 2005-2006 through 2017-2020 National Health and Nutrition Examination Survey waves were analyzed in 2024-2025. Differences in the consumption of any sugar-sweetened beverage, mean sugar-sweetened beverage kilocalorie, and percent of total kilocalories from sugar-sweetened beverages on a given day across a validated 4-category variable of water insecurity (based on tap water avoidance) and food insecurity (using the U.S. Food Security Survey Module) were assessed with log-binomial and linear regressions. RESULTS:Compared with children with water security and food security, children with water insecurity and food security had a 13% (95% CI=1.06, 1.19; p<0.001) higher prevalence ratio of consuming any sugar-sweetened beverage, consumed 23.3 more kilocalories (SE=6.7; p=0.001), and consumed 1.1% (SE=0.3; p<0.001) more total kilocalories from sugar-sweetened beverages. Children with water security and food insecurity had a 7% (95% CI=1.02, 1.12; p=0.002) higher prevalence ratio of drinking any sugar-sweetened beverage, consumed 13.2 (SE=5.1; p=0.01) more kilocalories, and consumed 0.8% (SE=0.2; p=0.001) more of their total kilocalories from sugar-sweetened beverage. Children experiencing water insecurity and food insecurity had a 15% (95% CI=1.08, 1.22; p<0.001) greater prevalence ratio of sugar-sweetened beverage intake, consumed 36.1 more kilocalories (SE=13.9; p=0.01), and consumed 1.8% (SE=0.4; p<0.001) more of their total kilocalories from sugar-sweetened beverages. CONCLUSIONS:Children experiencing water insecurity or food insecurity alone had higher sugar-sweetened beverage intake than children who had water security and food security, with children experiencing both water insecurity and food insecurity having the highest sugar-sweetened beverage intake. Addressing the intersection of water insecurity and food insecurity may help reduce sugar-sweetened beverage intake.

Background and objectives:Water is essential for proper physiological function. As temperatures increase, populations may struggle to meet water needs despite adaptations or acclimation; chronic dehydration can cause kidney damage. We evaluate how daily water requirements are associated with ambient temperature (ambT), wet bulb globe temperature (WBGT), urine specific gravity (USG; marker of hydration status), and albumin:creatinine ratio (ACR; kidney function biomarker) among Daasanach pastoralists living in a hot, dry northern Kenyan climate. Methodology:Water turnover (WT), USG, and ACR were measured using deuterium depletion (WT), refractometry (USG), and urine dipstick (ACR) for 76 participants aged 5-68 years in June 2022-23. Relationships between WT, ambT, WBGT, USG, and ACR were evaluated using linear and generalized linear models. Results:Adult WT was higher than mean values worldwide, peaking around 7 l/day. Water demands increase from childhood through middle age before falling in later life. Adult WT was not correlated with ambT or WBGT. About 2/11 children's and 7/36 adults' USG indicated dehydration; USG was not correlated with child WT but was negatively correlated with adult WT when accounting for body size. WT was lower among adults with high (≥30 mg/g) ACR; high ACR was associated with higher USG. Conclusions and implications:High Daasanach WT is likely driven by hot, semi-arid conditions, and lifestyle, rather than by compromised kidney function. Most participants were well-hydrated. Despite nonsignificant correlations between temperature and adult WT, high WT highlights the physiological demands of hot, dry climates. As climate change increases the global population exposed to hotter temperatures, global water needs will likely increase.

Global economic development has been associated with an increased prevalence of obesity and related health problems. Increased caloric intake and reduced energy expenditure are both cited as development-related contributors to the obesity crisis, but their relative importance remains unresolved. Here, we examine energy expenditure and two measures of obesity (body fat percentage and body mass index, BMI) for 4,213 adults from 34 populations across six continents and a wide range of lifestyles and economies, including hunter-gatherer, pastoralist, farming, and industrialized populations. Economic development was positively associated with greater body mass, BMI, and body fat, but also with greater total, basal, and activity energy expenditure. Body size-adjusted total and basal energy expenditures both decreased approximately 6 to 11% with increasing economic development, but were highly variable among populations and did not correspond closely with lifestyle. Body size-adjusted total energy expenditure was negatively, but weakly, associated with measures of obesity, accounting for roughly one-tenth of the elevated body fat percentage and BMI associated with economic development. In contrast, estimated energy intake was greater in economically developed populations, and in populations with available data (n = 25), the percentage of ultraprocessed food in the diet was associated with body fat percentage, suggesting that dietary intake plays a far greater role than reduced energy expenditure in obesity related to economic development.

Background Climate change is increasing temperatures, frequency of heatwaves, and erratic rainfall, which threatens human biology and health, particularly in already extreme environments. Therefore, it is important to understand how environmental heat stress measures are tied to human water needs and thermoregulation under increasingly hot conditions.Aim To test how ambient temperature, heat index, and wet bulb globe temperature (WBGT) relate to hydration status and thermal heat perception in a hot, semi-arid environment.Subjects and methods Urine samples, perceived heat stress, and anthropometrics were collected among Daasanach semi-nomadic pastoralists (n = 187 children, n = 231 adults) in northern Kenya. Environmental heat stress measures were recorded at sample collection; samples’ urine specific gravity (USG) was measured.Results Multiple linear and logistic regressions indicate that all environmental heat stress measures were associated with USG, odds of dehydration, and heat perception. Ambient temperature performed marginally better than WBGT, and both performed better than heat index. These associations were stronger among children than adults.Conclusion In a hot, semi-arid climate, ambient temperature and WBGT accurately predict human water needs and heat stress, with children more vulnerable to dehydration. To mitigate consequences of extreme heat, local bioculturally-appropriate hydration (e.g. tea) and cooling (e.g. shade) strategies should be encouraged.

BACKGROUND:Emerging evidence indicates water insecurity (WI) is detrimental to nutritional outcomes and dietary choices. OBJECTIVE:WI experiences were measured alongside market and traditional sugar-sweetened beverage (SSB) consumption in a small-scale society experiencing the early stages of a nutrition transition (ie, lifestyle and dietary changes away from traditional foods) to test how they are associated. DESIGN:The 12-item Household Water Insecurity Experiences (HWISE) scale was implemented along with a cross-sectional retrospective survey of beverage intake and sociodemographic characteristics across 5 communities at varying distances from a market town. PARTICIPANTS/SETTING:Participants were Tsimané forager-horticulturalist adults aged 16 years and older (n = 455; 47% were women) in lowland Bolivia from April through May 2019. MAIN OUTCOME MEASURE:Sugar-sweetened beverage consumption and traditional beverage consumption were measured. STATISTICAL ANALYSES PERFORMED:Multivariate logistic and Poisson regressions were performed, adjusting for possible confounding variables, including age, gender, income, household water needs, and community residence. RESULTS:Using logistic regressions, each point higher WI (HWISE) score was associated with 23% (95% CI 1.01 to 1.50; P = .035) and 27% (95% CI 1.06 to 1.52; P = .008) higher odds of consuming an SSB in the past week for men and women, respectively. For men, each point higher HWISE score was associated with 13% (95% CI 1.10 to 1.16; P < .001) higher odds of drinking chicha fuerte (ie, a traditional, homemade fermented beverage with antibacterial properties) and 16% (95% CI 1.02 to 1.32; P = .022) higher odds of consuming liquor. SSB consumption was highest in the closest communities to the market town and declined significantly with distance; and traditional beverages, such as chicha dulce (a sugar-sweetened, unfermented homemade chicha), were lowest in the close communities and increased with distance to the market town. CONCLUSIONS:Among Tsimané adults living in the Bolivian Amazon experiencing the nutrition transition, WI was associated with greater SSB intake. Distance to the main market town shaped access and preferences, as it was associated with SSB and traditional beverage consumption.

IntroductionVitamin A is essential for maternal and child health and plays a key role in reducing maternal and child mortality rates. A need exists for more evidence on the prevalence and associated factors of Vitamin A deficiency (VAD) among pregnant women in rural, underserved areas, such as eastern Ethiopia, where many risk factors for VAD may be concentrated.MethodsA community-based cross-sectional study was conducted with 397 randomly selected pregnant women at the Haramaya University Demographic Health Surveillance sites. Data were collected through structured questionnaires, anthropometric measurements, blood serum samples, and other relevant household and individual-level information. Vitamin A deficiency (VAD) was defined as serum retinol levels <0.7 μmol/L, while marginal deficiency was defined as 0.70–1.05 μmol/L. Bivariable and multivariable logistic regression analyses were used to identify factors associated with VAD.ResultsApproximately 48.1% (43.1–53.1%) of pregnant women in eastern Ethiopia had subclinical vitamin A deficiency (VAD), with a mean serum retinol concentration of 0.82 (±0.02) μmol/L. Only 122 (30.7%) and 159 (40.1%) of the participants reported having adequately diversified diets and adequate food variety scores, respectively. The use of khat (a stimulant) (adjusted odds ratio [AOR] = 1.67; 95% CI: 1.08–2.57) and a lack of awareness regarding vitamin A-rich foods (AOR = 1.67; 95% CI: 1.04–2.68) were found to be positively associated with VAD. Khat chewing was responsible for approximately 40.1% of VAD cases. Additionally, greater educational attainment of the husband (AOR = 0.47; 95% CI: 0.25–0.90) was significantly protective against subclinical VAD.ConclusionAlmost half of the pregnant women in this eastern Ethiopian sample were found to have subclinical VAD, highlighting the need for nutritional education during antenatal care and community nutrition awareness campaigns by various stakeholders. Context-specific, targeted behavioral change communications are essential to improve dietary practices and healthcare utilization.

Over 43 million people in the United States rely on private drinking water supplies for domestic purposes, yet 20% of water wells are potentially contaminated in some form. In Pennsylvania, 2-3 million rural residents use private water supplies for domestic purposes, yet Pennsylvania has no state-wide well drilling standards or water quality testing requirements for private water sources. The lack of implemented standards and monitoring hides potential water supply and quality issues and may affect water trust, health, and overall water insecurity. Therefore, we conducted two interlinked systematic reviews to understand (1) social perspectives around water insecurity among private water supply users in Pennsylvania and (2) associations between private water sources and health outcomes. Using Scopus, Web of Science, PubMed, ProQuest, Compendex, and Google Scholar, we identified 10 articles (n1) for the first review and 15 for the second (n2). Results indicated water insecurity relates to perceived and measured water quality problems. Common sources of water quality issues were chemical contamination (n1 = 5, n2 = 8), biological contamination (n1 = 3, n2 = 7), and proximity to shale gas drilling (n1 = 6, n2 = 4). Four articles measured health effects including thyroid health, risk for Parkinson's disease, and effects related to TCE/PCB contamination and proximity to shale gas drilling, while others discussed poor water quality potentially causing gastrointestinal illnesses. These reviews indicate opportunities for increased water testing for private water users and education for water quality health risks. Emerging literature emphasizes a surge of research interest in examining the social perceptions and health effects of water in Pennsylvania. This article is categorized under: Engineering Water > Water, Health, and SanitationHuman Water > Water GovernanceScience of Water > Water Quality.

Brewis, Workman et al. (2020) provided a basis for significant subsequent advancement in understanding the interplay between household water insecurity and food insecurity across diverse global contexts. This commentary reflects on the subsequent evolution of research and its application in the 5 years since the study's initial online publication in AJHB, highlighting dynamic mechanisms that link water insecurity and food insecurity and the implications for human health. Newer studies suggest that water insecurity may drive food insecurity more significantly than vice versa, with localized case studies revealing the diversity and complexity of multi-scalar factors that contribute to these relationships. Future research priorities include more refined water insecurity measurement tools and further testing of potential mechanisms in theorized causal pathways linking water insecurity and food insecurity to each other and health outcomes.

BACKGROUND:Salt leaching into freshwater is an emerging global environmental health concern. We tested the associations between drinking water salinity and blood pressure, hypertension, and albuminuria. METHODS:We conducted a 2-year panel study in 2022 and 2023 with 434 observations among 327 Daasanach adults aged >18 years in northern Kenya. Water sources were analyzed for overall salinity and ionic composition (sodium; chloride; calcium, potassium, magnesium). We measured resting blood pressure and classified hypertension stage 1 and stage 2. Urine samples were analyzed for albuminuria (≥30 mg/g albumin-to-creatinine ratio). RESULTS:Drinking water salinity was driven by sodium-chloride (mean=162.6 mg/L, SD=77.1), with low concentrations of calcium, potassium, and magnesium (mean=45 mg/L, SD=13.5). Across 2022 and 2023, 40.1% of adults had at least hypertension stage 1, 13.5% had hypertension stage 2, and 42.2% had albuminuria. Using random effects linear and logistic panel regressions fully adjusted for confounders, each 100 mg/L of drinking water sodium-chloride was associated with 4.5 mm Hg (95% CI, 2.4-6.6) and 3.3 mm Hg (95% CI, 2.2-4.5) increases in systolic and diastolic blood pressure, 3.0× the odds of at least hypertension stage 1 (95% CI, 1.49-5.83), 3.6× the odds of hypertension stage 2 (95% CI, 1.93-6.81), and 2.0× the odds of albuminuria (95% CI, 1.28-3.06). Calcium, potassium, and magnesium were unassociated with any outcomes. Hypertension stage 2 (but not hypertension stage 1) was associated with 2.6× (95% CI, 1.19-5.77) the odds of albuminuria. CONCLUSIONS:Drinking water sodium-chloride was associated with resting blood pressure, hypertension, and albuminuria in a population with few traditional lifestyle risk factors for chronic disease. Measuring specific salts in water helps untangle associations with hypertension.

Climate change is triggering environmental mobility through chronic water problems and punctuated events. Thinking about moving locations, or “mobility ideation”, is the precursor to migration intentionality and actual migration. Drawing on the embodiment construct, this study examines how the worst drought in recent history in the Horn of Africa affected water-related mobility ideation and, in turn, fingernail cortisol concentration (FCC), a chronic stress biomarker, among Daasanach semi-nomadic pastoralists in northern Kenya. To address these questions, we primarily draw on survey, anthropometric, water quality, and biomarker data among 175 adults living in seven communities in 2022. We used mixed-effects ordered logistic regression to test how livestock wealth, water insecurity, food insecurity, and anxiety/depression symptom scores were associated with household mobility ideation. We then used generalized linear models to test the association between mobility ideation on FCC. Thinking about moving at least once due to water problems increased from pre-drought in 2019 (55%) to during the drought in 2022 (92%), while actual mobility declined. Livestock wealth, while associated with actual mobility in the prior year, was protective against increased mobility ideation, while water insecurity, food insecurity, and anxiety/depression symptoms were associated with greater odds of thinking of leaving in 2022. Compared to adults who did not consider moving, those who considered moving rarely, sometimes, and often had FCC levels 18.1% higher (95% CI, 1.01-1.38; p=0.039), 19.4% higher (1.01-1.41; p=0.040), and 32.3% higher (1.01-1.73; p=0.039), respectively, with results consistent in sensitivity analyses. Extreme climatic events in water scarce regions may increase mobility ideation through worsened experiential indicators of well-being and resource insecurity. Mobility ideation may capture measures of adversity suffered by pastoralists and signify climate distress. This research broadens understanding of how droughts get under the skin by leading to resource insecurity and triggering thoughts of moving, which increases chronic stress.

An increasing number of studies find that water sharing—the non-market transfer of privately held water between households—is a ubiquitous informal practice around the world and a primary way that households respond to water insecurity. Yet, a key question about household water sharing remains: is water sharing a viable path that can help advance household water security? Or should water sharing be understood as a symptom of water in security in wait for more formalized solutions? Here, we address this question by applying Sen’s entitlement framework in an integrative review of empirical scholarship on household water sharing. Our review shows that when interhousehold water sharing is governed by established and well-functioning norms it can serve as a reliable transfer entitlement that bolsters household water security. However, when water sharing occurs outside of established norms (triggered by broader entitlement failures) it is often associated with significant emotional distress that may exacerbate conditions of water in security. These findings suggest that stable, norm-based water sharing arrangements may offer a viable, adaptive solution to households facing water insecurity. Nevertheless, more scholarship is needed to better understand when and how norm-based water transfer entitlements fail, the capacity of water sharing practices to evolve into lasting normative entitlements, and the impact of interhousehold water sharing on intrahousehold water security.